6/13/2016
Client Centered and LBGTQI Participants will explain the major problems that affect A Client Centered Approach to members of the LGBTQI community Working with LGBTQI Individuals Participants will describe what it means to be gender variant Participants will assess if individuals fit the criteria for a Presented by Francien Chenoweth Dorliae Gender Dysphoria Diagnosis in DSM-V Psy.D. & Amanda Cyr B.A. Participants will be able to explain why Client Centered Therapies are a good fit when working with this population Participants will apply Client Centered principles in therapy with LGBTQI individuals
Terms Cis-gender: A “match” between assigned gender and felt gender
Cross-Dresser/Transvestite: Someone who occasionally wears clothing that is The LGBTQI Community typical of another gender. Cross-Dressers do not necessarily wish to change genders
Drag King/Queen: Wearing the clothing of another gender, sometimes in an exaggerated or stereotypical way. People use the terms Drag King and Drag Queen when performing gender as parody, entertainment, or art
Female to Male: Used to identify a person assigned female at birth who identifies as male or masculine, or lives as a man
Gender: A social construct based on emotional and psychological characteristics that classify someone as feminine, masculine, androgynous, or other
Gender Binary: The exclusive categories of male and female
Gender Identity: The inner sense of being a man, a male, a woman, a female, both, neither, butch, femme, two-spirit, bi-gender, or another configuration of gender. A person’s “self- concept of their gender” (Moleiro & Pinto, 2015). Using These Terms Genderqueer/Gender Fluid: Used when someone feels they do not fit on the spectrum of It is important in practice you use the terms your trans but identifies their gender on the continuum between or outside of the gender binary client is most comfortable with Intersex: Term used for people born with a reproductive or sexual anatomy that does not fit the typical definitions of male or female If you begin working with someone who is transgender or gender nonconforming ask them what Male to Female: Used to identify a person assigned male at birth who identifies as female or feminine, or lives as a woman pronouns and proper names they prefer to be called Some clients may not identify as male or female so in Passing: The process by which a trans persons gender identity is perceived by others in a way that is consistent with their experience of their gender identity your reports and case notes try to avoid using those pronouns and use the client’s name Transgender: Those who transgress social gender norms. Often used as an umbrella term to encompass transsexuals, genderqueers, cross-dressers, and gender non-conformists.
Transsexual: People who are severely uncomfortable with the mismatch of their assigned and felt genders and are working towards living as their felt gender. Transsexuals often take steps in order to bring their assigned gender into alignment with their felt gender (surgery, hormone injections, etc.)
1 6/13/2016
Examples Psychological Problems Faced
This is What Trans Media Portrayals Internalized transphobia Looks Like Orange is the New Black Results from internalizing negative messages based on society's expectations of what is considered normal Being Intersex Uses a transgender actress to portray a trans character Increased rates of depression and anxiety compared to the Being Genderqueer Trans characters have been total population traditionally portrayed by Higher risk of suicide cis-gender actors and Decreased sense of social support from family and loved ones actresses Higher risk for mental distress because of experiences of Jared Leto (Dallas Buyer’s Club) discrimination Jeffrey Tambor (Transparent) Felicity Huffman (Transamerica) Psychological effects of trauma Kathleen Turner (Friends) Violence perpetrated against the individual or a close friend Eddie Redmayne (The Danish Girl) within the LGBTQI community could be very traumatic
List of Trans Individuals Honored on Trans Remembrance Day Sociological Problems Faced (International List, 2015) 40. Carol Melo, (30 years old) Strangled to death 41. Priscilla da Silva, 1. Keyshia Blige (33 years old) Shooting 2. Tamara Dominguez (36 years (23 years old) Gunshot 42. Barbara Sodre, (29 years old) Stabbed to old) Repeatedly run over by vehicle 3. Kandis Capri (35 years old) death 43. Jean Waltrick, (27 years old) Multiple gunshot wounds to the Discrimination Shooting 4. Amber Monroe (20 years old) Gunshot 5. Ashton O'Hara (25 head 44. Vandressa Vinnitt (no age given) Gunshot 45. Ticiane years old) Stabbed to death, ran over by vehicle 6. Shade Schuler (22 years Abravanel, (21 years old) Gunshot 46. La Monique de Roma, (43 years old) Gunshot 47. Unidentified (no age given) Gunshot 48. Stefanny (no old) Unidentified, found dead in a field 7. K.C. Haggard (66 years old) age given) Gunshot 49. Job Rodrigues da Silva, (46 years old) Gunshot Employment, education, housing, health care Multiple stab wounds 8. India Clarke (22 years old) Gunshot to the head 50. Unidentified (no age given) Beaten and strangled to death 51. Bruna, and arm 9. Mercedes Williamson (17 years old) Beaten to death 10. Penny (47 years old) Gunshot 52. Bruna Quércia, (15 years old) Gunshot 53. Also being discriminated against in interpersonal Proud (21 years old) Shooting 11. Taja Gabrielle DeJesus (36 years old) Victória Camargo, (29 years old) Gunshot 54. Bruna Michele, (20 years Multiple stab wounds 12.Bri Golec (22 years old) Stabbed to death 13. old) Beaten to death 55. Vanessa Ganzaroli, (18 years old) Multiple stab wounds 56. Debora (no age given) Stoned to death 57. Lotinha (no age relationships and often times by family members Lamia Beard (30 years old) Shooting 14. Papi Edwards (20 years old) given) Stabbed 58. Adriana, (22 years old) Multiple gunshots 59. Bianca Shooting 15. Nephi Luthers (20 years old) Shooting 16. Diosvany Muñoz Araujo, (21 years old) Gunshot 60. Michael Lucas de Almeida Reginald, Robaina (24 years old) Stoning 17. C.N. Alves de Matos Jr (21 years old) (13 years old) Beaten, multiple stab wounds 61. Natália Ferraz, (21 years Stigma Stabbed and dismembered 18. Unidentified (41 years old) Severe head and old) Multiple gunshots 62. Ygor Fernando Oliveira Santos, (20 years neck trauma 19. L.A. de Souza, (22 years old) Found in landfill with knife old) Multiple gunshots 63. Keity, (23 years old) Stabbed 10 time 64. Lara, (16 years old) Stoned to death 65. Unidentified (no age given) Social exclusion in neck 20. Waleska Rayala, (21 years old) 27 stab wounds 21. Paulinha Multiple gunshot wounds 66. Raíssa, (19 years old) Multiple stab (no age given) Gunshots to head and chest 22. Flower, (39 years old) wounds to neck and chest 67. Capitú Santos, (31 years old) Stabbed 68. Beaten to death 23. V.H.A dos Santos , (25 years old) Multiple gunshot Joyce Akira, (teen) Multiple gunshot wounds 69. Pata, (35 years old) Economic alienation wounds 24. Patricia, (29 years old) Unidentified cause of death, thrown Strangled to death 70. Didinha, (18 years old) Multiple gunshot wounds into bush 25. Unidentified, (45 years old) Gunshot wound to the head 26. 71. Unidentified (no age given) Gunshot 72. LÉO, (26 years old) Gunshot 73. Piu da Silva, (25 years old) Beaten, multiple gunshot Gabi, (26 years old) Beaten to death 27. Erika Aguilera, (25 years old) wounds 74. Unidentified (no age given) Gunshot wound 75. Homelessness, especially among LGBTQI youths Gunshot wound to the back 28. India Nascimento, (29 years old) Beaten Unidentified (no age given) Gunshot wound 76. Diana Sacayán, (39 to death 29. L.R.O. Dorta, (26 years old) Decapitated 30. Vanessa Calaça, years old) Multiple stab wounds 77. Marcela Chocobar, (26 years old) (27 years old) Stoned to death 31. Unidentified (no age given) Multiple Dismembered and burned 78. Francela Méndez (no age given) Stab Violence perpetrated against transpersons and other non- gunshot wounds to the back and abdomen 32. Unidentified (no age given) wounds 79. Fernanda "Coty" Olmos (59 years old) Stab wounds, Stab wound to the neck 33. Bruna J. Mendes, (27 years old) Multiple suffocated with bag over head 80. Yoshi Tsuchida (38 years old) Face cut off, bag around head 81. Leticya Santos Ignácio (21 years old) binary individuals; bullying, abuse, persecution gunshot wounds 34. Sidney Araújo Claudino, (19 years old) Shotgun Gunshot to the forehead 82. Unidentified (19 years old) Gunshot to the gunshot wound to the chest 35. Laura Vermont, (18 years old) Beaten to face 83. Miscilene (25 years old) Blunt force trauma to the head 84. High rates of violent crime and murder against homosexuals death by police 36. Kauane da Silva, (35 years old) Gunshot to the head 37. Miscilene (20 years old) Gunshots 85. Tiffany Latifah (24 years old) Unidentified (no age given) Unidentified cause of death, buried in shallow Stab wound to the neck 86. Unidentified woman (no age given) grave 38. Kelly Silva, (31 years old) Stabbed in neck and arm 39. Andréia Gunshot wounds to head and abdomen 87. Tiffany Latifah (17 years old) and transgenders Gunshot wounds to face and back 88. Anusha (no age given) Murdered Amado, (29 years old) Gunshot and burned 89. Pravalika (24 years old) Bludgeoned to death 90. Hande Ö (35 years old) Strangled
Statistics Other Sociological Problems In the first 10 months of 2011, 225 transgender people were Higher High School drop out rates for teenagers killed Inappropriate use of pronouns and inappropriate personal questions These questions are usually about the persons physical genitalia and sexual Transgender women accounted for 44% of gay and orientation transgender murder victims in 2009 though they only account Job discrimination for 9% of the LGBT population Marriage equality 14% of transgender people report being a victim of rape “In 1999 a court in Texas invalidated a seven-year marriage between Christine Littleton, a transgender woman, and her deceased husband. The case arose when Ms. Littleton brought 75% of transgender youth report being harassed a wrongful death suit seeking damages for her husband's death as a result of alleged medical malpractice. Rather than ruling on the merits of Ms. Littleton's suit, the court held that a Over 50% of transgender people have reported being violently person's legal sex is genetically fixed at birth and that Ms. Littleton should be deemed to be legally male, despite her female anatomy and appearance, and despite the fact that she had assaulted lived as a woman for most of her adult life. As a result of that decision, Ms. Littleton was According to a 2011 report, 19% of transgenders in the US denied all of the rights afforded to a legal spouse—not only the right to bring a wrongful death suit, but the right to intestate inheritance (or inheritance without a will), to obtain reported being denied medical care due to their transgender or her deceased husband's Social Security and retirement benefits, and many others as well.” non-conforming status (http://www.hrc.org/resources/transgender-people-and-marriage-the-importance-of- legal-planning) 64% of transgender people report suicidal feelings as a result of Passing can perpetuate the idea that a person is only beautiful or transphobic violence or traumatic instances acceptable in society if they look like they belong in the binary, this is known as Marxist Trans (Harris, 2011)
2 6/13/2016
North Carolina House Bill 2 “House Bill 2 declares that state law overrides all local ordinances concerning wages, employment and public accommodations…the law now bars local municipalities from creating their own rules prohibiting discrimination in public places based on sexual orientation and gender identity. Though North Carolina does have a statewide nondiscrimination law, it does not include specific protections for LGBTQ people. No trans individuals have ever been The law also directs all public schools, government agencies and public arrested for sexual misconduct in college campuses to require that multiple-occupancy bathrooms and bathrooms but three US law makers have changing facilities, such as locker rooms, be designated for use only by been (http://www.patheos.com/blogs/progressiv people based on their "biological sex" stated on their birth certificate. esecularhumanist/2016/04/more-gop- Transgender people can use the bathrooms and changing facilities that lawmakers-arrested-for-sexual- correspond to their gender identity only if they get the biological sex on misconduct-in-bathrooms-than-trans- their birth certificate changed. Under the law, public institutions can still people/) offer single-occupancy facilities.” (http://abcnews.go.com/US/north- carolinas-controversial-anti-lgbt-bill-explained/story?id=37898153)
Bathroom Legislation
Microagressions “everyday verbal, nonverbal, and Protective Factors environmental slights, snubs, or insults, whether intentional or Social & Family Support unintentional, which Gay Straight Alliance communicate hostile, Parents, Families, and Friends of Lesbians and Gays derogatory, or negative messages to target persons (PFLAG) based solely upon their Human Rights Campaign marginalized group It Gets Better Project membership” Low Internalized Homophobia or Transphobia Realistic expectations of acceptance and rejection
Ridiculous Propaganda Contact with other individuals in the LGBTQI (There has only ever been one community reported case, in Canada, of an individual cross dressing to Religiosity perpetrate sexual or physical violence in a restroom in 35 years)
3 6/13/2016
Success Stories Athletes Success Stories Continued Chris Mosier: First openly trans person to compete Actors/Models on an USA Olympic team Laverne Cox: Trans actress playing a trans character on the hit Renee Richards: Allowed to play in the US Open as series Orange is the New Black and she will be playing Dr. Frank- a woman after legislation was passed that N-Furter in The Rocky Horror Picture Show reboot, she is also a prominent activist and speaker in the LGBTQI community established transsexuals are legally accepted in their new identity after reassignment surgery Carmen Carerra: A petition has been started to make her the first Victoria’s Secret transgender “Angel” Kye Allums: First openly transgender athlete in Candis Cayne: First trans actress to play a recurring trans NCAA Division 1 character Caitlyn Jenner: All of her Olympic records were Caroline Cossey: Transgender actress who played the famous amended to reflect her felt identity role of a Bond girl in For Your Eyes Only and the first transgender Lana Lawless: Sued to have the “female at birth” woman to model for Playboy rule removed from the LPGA rules so she could Andreja Pejic: First transgender model to appear in American compete Vogue Fallon Fox: First openly transgender mixed martial Geena Rocero: Model and involved in the advocacy group arts fighter Gender Proud Isis King: First transgender woman to compete on America’s Next Top Model
Success Stories Continued Role of Families One transgender writer, Chris Edwards, believes that more prominent Transgender success stories would breed more supportive and accepting Competitors families. Jenna Talackova: First openly transgender candidate to compete in Miss Universe Parental and familial support is crucial in developing a healthy sense of Canada in 2012, after initially being rejected gender identity because of her gender status Non-binary and non-cis gender identification should not be seen as Writers/Composers unhealthy and should be treated with respect, love, and support. Lana & Lilly Wachowski: Trans siblings “The role of coping within the family unit was related to making meaning of who worked on the Matrix franchise, and gender within the family and accepting the youth’s gender identity” film adaptations for V for Vendetta and Cloud (Budge, Adelson & Howard, 2013, pg. 546) Atlas Too often families who do not understand the struggles of their trans Janet Mock; Author of Redefining Realness children will kick them out of the house, disown their children, or shame Chaz Bono: Writer and LGBTQ activist them Kate Bornstein: Author of the transgender manifesto Gender Outlaw Transgender individuals often perceive that they receive less social support Wendy Carlos: Composed the soundtrack from their family members than their non transgender siblings (Budge, for A Clockwork Orange, The Shining, and Tron Adelson & Howard, 2013) Leelah Alcorn
Families continued DSM V: Gender Dysphoria
• An incongruence between experienced/expressed gender and • One famous family, Brad Pitt and assigned gender, of at least 6 months, manifested as two of the Angelina Jolie, have gained a lot of following symptoms attention from the media because one of their biologically female – Incongruence between experienced gender and primary children identifies with the and/or secondary sex characteristics masculine gender and wishes to be – Strong desire to be rid of one’s primary/secondary sex called John. Angelina and Brad characteristics have been very accepting and – Strong desire for the primary/secondary sex characteristics supportive allowing John to wear of the other gender the clothes he wants and to style – Strong desire to be the other gender his hair how he sees fit – Strong desire to be treated as the other gender • The media however has been just terrible, attempting to shame the – Conviction that one has the typical feelings and reactions couple for the acceptance of their of the other gender child’s masculine identity and • The condition is associated with clinically significant distress claiming this parenting style is or impairment in social, occupational, or other important areas harmful for the child of functioning (American Psychiatric Association, 2013)
4 6/13/2016
Why Gender Dysphoria is Important
• The change from Gender Identity Disorder in DSM-IV to Gender Dysphoria in DSM-V was meant to lessen the stigma associated with the diagnosis • “It is a clinical term used to describe the symptoms of excessive pain, Client Centered Therapy agitation, restless, and malaise that gender-variant people seeking therapy often express” (Moleiro & Pinto, 2015, pg. 3) • The diagnosis is only given to individuals who are severely distressed by the incongruence they feel between their expressed and assigned genders – Not all trans people have gender dysphoria! • The addition of the specifier concerning transition status is another important aspect of the diagnosis – The specifier ensures treatment access to those undergoing hormone therapy treatments, getting related surgeries, or seeking psychotherapy during their transition – Insurance helps pay for medical procedures relating to transitioning if the person is diagnosed with gender dysphoria
(American Psychiatric Association, 2013)
Overview History Developed by Carl Rogers Developed in 1920’s by Carl Rogers Uses a positive view of individuals Way of being Worked with “troubled” children Emphasizes understanding and caring His Belief Necessary conditions for therapeutic change “most children if given a reasonably normal Client must be anxious or incongruent environment which meets their own Client must be in contact with the therapist Therapist emotional, intellectual and social needs, have Genuine within themselves sufficient drive toward Accepting health to respond and make a comfortable Offer unconditional care Empathic adjustment to life.”
History Basic Concepts • Interested in Four Elements of Relational Therapy Actualizing Tendency (1938) Self • Emphasis on the quality of the Therapeutic relationship Ideal Self • Focus on enabling clients to “experience and realize” their own Self-Actualization attitudes Congruence • Acceptance of clients Incongruence • Clarification of client’s feelings and acceptance of the client Psychological Adjustment • Roger’s basic elements Psychological Maladjustment • A sympathetic, understanding, respect for the client • An understanding of the self and of the client
5 6/13/2016
Basic Concepts Basic Concepts
Actualizing Tendency Self Roger (1959) Self-concept, Self-structure “The inherent tendency of the organism to develop all its Roger (1959) – “an organized, consistent conceptual gestalt capacities in ways which serve to maintain or enhance the composed of perceptions of characteristics of the “I” or organism” ‘me’…together with the values attached to these perceptions” Self/self-concept – represents an external view of the self It is a natural function for people to move toward differentiation, growth, wholeness, integration, etc. Ideal Self Foundation for client-centered psychotherapy view of self that the person would like to be
Phenomenology and the ‘Self’ Phenomenology and the ‘Self’ Our ‘Self’ is fluid and changing. “Rogers referred to an individual’s unique “An organized consistent gestalt, constantly in the perception of the world as their phenomenal field”. process of forming and reforming”. (Rogers 1959: p201). Dynamically changing, reflecting the actualizing “We live by a perceptual map which is never tendency. reality itself”. The Self: Our perceptions of external reality are what shapes our Who we are at a given moment. lives. Influenced by the factors that shape perception. The most significant influence on how we act in Guided by our ‘actualizing tendency’. our phenomenal field is our sense of self. “The Self may … reflect the past, but it is not constrained by it; it is always possible for a new pattern to emerge…”.
(Glassman and Hadad 2004: p260 / 1). (Glassman and Hadad 2004: p261).
The Organism and the The Ideal Self, Congruence and ‘Actualizing Tendency’ Incongruence ‘Self’ and ‘Ideal Self’: We have physical needs arising from the biological nature of our being. “… who we would like to be, and the goals and aspirations we have for our lives”. “The actualizing tendency reflects (our) desire to grow, to develop and to enhance (our) capacities”. The ‘Ideal Self’ can be similar to the real ‘Self’ or radically different. An intrinsic part of our/all life. If they are similar, a person experiences a sense of Capacity to guide and direct our behaviour “in to ways that foster growth and happiness”. ‘congruence’ or integration. If they are dissimilar a person experiences a sense of incongruence, contradictions and a mismatch / anxiety.
(Glassman and Hadad 2004: p260). (Glassman and Hadad 2004: p261 / 2.)
6 6/13/2016
Basic Concepts Incongruence Congruence Gap between the real self and the ideal self “ the I am” and the “ I should” State in which the person’s self-concept and The greater the gap, the more incongruity experiences (thoughts, feelings, and behaviors) are in harmony The more incongruity, the more suffering Incongruity is what Rogers means by neurosis Incongruence Being out of synch with your self A state of discrepancy between a person’s thoughts, feelings or actions and the way they see themselves
Basic Concepts Defenses
When you are in a situation where there is an incongruity between Psychological Adjustment your image of yourself and your immediate experience of yourself, you The concept of self is congruent and integrated , are in a threatening situation. which allows experiences to be assimilated on a Example: You have been taught to feel unworthy if you do not get all symbolic level into the gestalt of the self-structure A’s and yet you are not really that a “all A student”, then situations such as test are going to bring that incongruity to light-test will be Psychological Maladjustment very threatening. The person denies or distorts in awareness, significant experiences, which creates an Threatening situation cause anxiety. Anxiety is a signal indicating that there is trouble ahead, that you should avoid the situation. We tend to incongruence between self and experience psychologically avoid situation by using defenses.
Defenses Defenses Roger’s ideas of defenses=Similar to Freud’s except Every time a person uses a defense, he/she put a that Rogers considers everything from a greater distance between the real and ideal self perceptual point of view ( memories and impulses are thought of as perceptions) They become ever more incongruous, and find Roger’s proposed two defenses: themselves in more and more threatening situations, Denial develop greater and greater levels of anxiety, and use Block out threatening situation more and more defenses.... It becomes a vicious cycle Keeping a memory or impulse out of your awareness-refuse to perceive it ( a person never picks up test so he does not have to face poor grades) that the person eventually is unable to get out of, at Perceptual distortion least on their own Reinterpreting the situation so that it appears less threatening( similar to Freud’s rationalization ( student that is threatened by tests and grades may blame the professor )
7 6/13/2016
Defenses Psychosis As per Rogers ( partial explanation) Psychosis occurs when a person's defense are overwhelmed, and their sense of self becomes "shattered" into little disconnected pieces. His behavior likewise has little consistency to it. We see him as having "psychotic breaks" -- episodes of bizarre behavior. His words may make little sense. His emotions may be inappropriate. He may lose the ability to differentiate self and non-self, and become disoriented and passive.
Basic Concepts Relating to Fully Basic Concepts Relating to Personality Functioning Person Development Experience Positive Regard Everything that is going on within the person Unconditional Positive Regard at any moment which is or could be brought Positive Self-regard into awareness. Unconditional Self-Regard Openness to Experience Ability to take in information from within or from the external environment without defensiveness
Basic Concepts Personality Development Conditions of Worth Development is influenced by the nature and quality of social interaction. Locus of Evaluation “Positive regard”: Organismic Valuing Process (organisms know what is Positive social contacts may provide a feeling of good for them- evolution has provided us with the senses, the tastes, the discrimination we need: we are hungry, we find food-not just any food, but belonging, being valued and loved. food that tastes good. Food that tastes bad is likely to be spoiled, rotten, Any form of attention is ‘positive regard’. unhealthy) Positive regard is so important, we may ignore other Internal Frame of Reference aspects of the Self in order to obtain it. External Frame of Reference Has an ‘evolutionary’ quality? We need social approval. Empathy
(Glassman and Hadad 2004: p263.)
8 6/13/2016
Personality Development Personality Development “Conditions of worth”: Conditional and Unconditional Positive Regard: Obtaining ‘positive regard’ is a measure of ‘self worth’, UPR is an acceptance and caring extended because we and can become an end in itself. are human. ‘Conditions of worth’ are often created externally by Regard for the person may be unconditional – while acceptance others (e.g. parents). of actions may still be conditional. Introjecting the values of others into our ‘ideal’ sense of CPR is extended for meeting certain standards of self can involve a distancing fro who we really are. behaviour. “When pleasing others becomes more important than … Creates a ‘mixed message’ where acceptable behaviour is one’s own actualizing tendency, then healthy growth is confused with an acceptable self. threatened.”
(Glassman and Hadad 2004: p263). (Glassman and Hadad 2004: p264 / 5.)
Conditions for Growth? Conditions for Growth? What fosters or creates ‘congruence’? The three conditions of growth will tend to be Unconditional positive regard, openness and empathy. Unconditional positive regard: experienced together. “…accepting each person has value without reference to what they do or don’t do … this other individual as a separate The conditions for growth are intended to allow a person to person having worth in his own right.” evaluate their own experiences based on their actualizing UPR allows the individual to develop a sense of self through their own actualizing tendency, perceptions and experiences. tendency. Openness (or congruence): The conditions are a ‘continuum’ – we try to express them. “ … a person freely expressing their own sense of self, rather than playing a role or hiding behind a façade”. It is the act of trying that is important. Rogers believed that openness also created increasing self- awareness. Empathy: The ability to understand another person’s feelings, perceptions and points of view. (Glassman and Hadad 2004: p266 / 7). (Glassman and Hadad 2004: p265).
Dynamics of Rogers Core Conditions Rogers: Core Conditions for Growth • “One way of assisting the individual to move towards openness to experience is through a relationship in which he is prized as a separate person, • in which the experiencing going on within him is empathically understood and valued, • and in which he is given the freedom to experience his own feelings and those of others without being threatened in doing so”.
(Rogers 1967: p24)
9 6/13/2016
The Outcome? The “Fully Functioning Person” “The Fully Functioning Person” The ‘ideal’ of growth is to be the fully functioning Openness to experience. person. Existential Living ( living in the here and Congruence produces a confidence and self-esteem now). that allows us an openness to experience our world and feelings. Trusting our ability to deal with the Organismic Trusting. world, we can experience spontaneity, self-direction Experiential freedom ( free choices when and compassion. choices are available to us). Creativity.
(Glassman and Hadad 2004: p268).
The ‘Mature Person’ Evaluating Rogers’ Theories? Being ‘real’. Being ‘who one is’. Expressing one’s Phrased broadly and generally. feelings honestly. Hard to measure or create means of evaluation (except Self-direction. Pride and confidence in one’s life via inter-subjective agreement). choices. Questionable whether we can define ‘ideal Valuing one’s self and feelings positively. development’. Focusing on life as a process rather than a goal. Cross-cultural studies would suggest the model of self Valuing openness – relationships – other people. might be inconsistent. Glassman and Hadad (2004: p270)
(Glassman and Hadad 2004: p269).
Evaluating Rogers’ Theories? Evaluating Rogers’ Theories? There is a ‘one size fits all’ quality to the A positive and constructive view of humanity. A hopeful ‘face value’ that has been and is inspiring theory? The same conditions work for all? to many. Do they? Provided the first focus in therapy away from ‘techniques’ Taken as ‘defined’ or ‘dogma’ by his and ‘professional power’ towards the quality of relationship. followers for many years. Only now being Has been built on in developments of Positive further developed. Psychology. Voted repeatedly (American Psychological A ‘turning point’ in psychology in his Association) as the most influential (Rogers’) focus on phenomenology. psychotherapist in the field.
10 6/13/2016
A Measure of Carl Rogers A Measure of Carl Rogers I have gradually come to one negative conclusion about the good life. It seems to me that the good life is not any fixed "In my early professionals years I was asking the state. It is not, in my estimation, a state of virtue, or question: How can I treat, or cure, or change contentment, or nirvana, or happiness. It is not a condition this person? Now I would phrase the question in which the individual is adjusted or fulfilled or actualized. To use psychological terms, it is not a state of in this way: How can I provide a relationship drive-reduction, or tension-reduction, or homeostasis. which this person may use for his own personal growth? The good life is a process, not a state of being. It is a direction not a destination." From On Becoming a Person, 1961
Summary Using Client Centered Therapy with “Man does not simply have the characteristics of a machine; he is not simply a being in the grip of the LGBTQI Community unconscious motives; he is a person in the process of creating himself, a person who creates meaning in life, a person who embodies a dimension of subjective freedom” “He is a figure who, though he may be alone in a vastly complex universe, and though he may be part of that universe and its destiny, is also able to live dimensions of his life which are not fully or adequately contained in a description of his conditioning or unconscious.” Rogers 1964: p129)
Gate Keeper Myth Previous Treatments Individuals who are distressed by the incongruence they feel may see psychologists as “gate keepers” or as people who grant LGBTQI individuals report for psychotherapy at higher rates than non-LGBTQI individuals or take away their access to insurance assisted surgery They may have had experiences with therapists that left a bad They may present in a way that seems artificial because they impression of what therapy is and what therapists do want to say the “right thing” to get the diagnosis, they may also LGBTQI individuals are at higher risk for ineffective or harmful appear guarded because they do not want to say the wrong therapies thing Some professionals still believe in the “merits” of conversion therapy “Trans people may feel the need to express a personal narrative Older individuals in the LGBTQI community may have painful memories of other treatments consistent with what they believe the clinicians’ expectations to A story from the 1960s: “She underwent electric shock treatment be, for accessing hormonal or surgical treatments” (Molerio & virtually every day for two weeks. The clinician had pasted a photo Pinto, 2015, pg. 4) of her face onto female catalogue models and administered a painful shock to her arms as she looked at each of them. Tired of pain and Some people may come to therapy in order to obtain insurance feeling no better, she eventually resorted to telling him she no longer for surgery but others may just come for therapy, not everyone thought she was a woman, and was promptly told to go and get is headed down the path to transition married in order to seal the cure” (Livingstone, 2008, pg. 142)
11 6/13/2016
A Client Centered Approach Providing unconditional positive regard, congruence, and empathy Adopting the client’s perspective “In a person-centered approach to therapy Encouraging the client’s locus of evaluation ‘the confused, tentative, and almost Emphasizing the client’s notion of self-concept incoherent thinking of an individual who Believing in the client’s capacity for growth knows he has been evaluated as abnormal is Ensuring the growth process is directed by the client really respected by being deemed well worth (Lemoire & Chen, 2005) understanding’” (Livingstone, 2008, pg. 138)
Unconditional Positive, Congruence, & Empathy Adopting the Client’s Perspective The client is given the opportunity to be honest about It is important to think about what the client their identity and/or sexual orientation perceives as their reality They can start to form a relationship that is not How your client processes information may be greatly founded on barriers and lies. influenced by how they grew up dealing with The therapist conveys a sense of hope to the client that stigmatization, and internalized homophobia or they will experience this acceptance and empathy in transphobia other important relationships in their life (Lemoire & Look at the important relationships in the client’s life Chen, 2005). and see how the client talks about family members and the level of support as perceived by the client
Emphasizing the Client’s Notion of Self- Encouraging the Client’s Locus of Concept Evaluation Client centered therapy offers the client an As self-esteem increases client’s may start to shift the environment and opportunity to work on positive self- basis of their values and standards from others to regard and improve upon their self-esteem themselves This would change their locus of evaluation from This environment also encourages a higher degree of external to internal self-exploration Client’s would begin to see that the standards and “The counseling process highlights and strengthens a values they set for themselves are more important than positive sense of self by allowing the client the the values and standards determined by others firsthand experience of self-exploration and self- “The individual must be helped to work out his own understanding” (Lemoire & Chen, 2005, pg. 149) value system with minimal imposition of the value system of the therapist” (Livingstone, 2008, pg. 140)
12 6/13/2016
Believing in the Client’s Capacity for Growth Meet the Client Where They Are Client Centered Therapy posits that people are Some individuals who are gender non-conforming or intrinsically oriented towards growth and self- transgender may seek therapy for reasons completely enhancement unrelated to gender identity. These individuals may be comfortable with their “Believing in the client’s capacity for and tendency gender identity but are having other problems with toward self-growth, the counselor functions as the anxiety, depression, or lack of social support. constructive facilitator who accompanies the client in Listen to your clients, find out what brought them to initiating a personal journey toward more self- treatment and keep the focus of therapy on what they awareness, self-confidence, and self-pride” (Lemoire & want to work on. Chen, 2005, pg. 150) Even if you are interested in talking about their gender identity or expression it is up to the client whether or not they want to discuss it with you.
Ensuring the Growth Process is Directed By the Client Compensating for Limitations The client will decide what he or she wants to work Provide explicit identity validation and reassurance to on in therapy the client The client is an expert on their own experience and The Client Centered approach usually avoids the use of feelings and should be given the freedom to direct the reassurance and aims to help guide the client through course of treatment however they see fit their feelings. If a topic is too painful for your client to discuss there With this population in particular it is important to is no reason to bring it up in session until the client is validate the client’s identity and normalize their ready to talk about it experience “It is not appropriate for the counselor to decide the most important issues to be discussed” (Lemoire & Chen, 2005, pg. 150)
Identity & Sexuality Disclosures Community Support Talk about risk assessment in the context of disclosing Provide resources so clients can find groups or sexuality or gender identity to others communities of their peers to socialize with Some clients may not have “come out” to important “Becoming acquainted with gay and lesbian people is people in their life and may wish to do so during the the most effective means for developing a positive course of therapy attitude toward acceptance. Such exposure normalizes the [individuals] identity and experiences Clients may not fully understand the positive and negative consequences that are associated with and dispels myths and stereotypes…” (Lemoire & Chen, 2005, pg. 153) disclosures of this nature As the therapist you will also provide a warm and supportive environment of acceptance but by engaging in a social group for LGBTQI individuals your client can hear and see success stories of acceptance firsthand from other members of their community
13 6/13/2016
The Case of Eliza Skills “Eliza is a 21-year-old, European-American transgender woman Affirm Eliza’s gender identity and recognize her resilience (assigned male at birth, but identifies as a woman) who is a college student and presents with concerns of stress regarding family Adopt Eliza’s perspective conflict and misunderstanding about her gender identity. She saw a Think about the impact on her familial relationships previous mental health practitioner for three years in another state Provide unconditional positive regard who supported her in accessing hormones and breast Acknowledge and support Eliza’s congruence augmentation. She reports using her financial aid checks to access necessary hormonal and surgical treatments because her insurance Help build Eliza’s self-esteem did not cover these procedures. Eliza has been disconnected from Recognize and encourage the development of Eliza’s locus of her family throughout her transition because of their refusal to evaluation accept her as their daughter or to use correct female pronouns. Provide community resources for Eliza to utilize as well Eliza states that she would like to reconnect with her family, who are now open to discussing her gender with her.” (Cornish et al. 2010, pg. 429)
Advocacy Quotes about Gender Be able to ask, understand, and explore the terms and pronouns that best fit the client’s lived experience Be a good ally • “Becoming fully alive to one’s internal sense of gender Look over paperwork and remove gender binary categories and provide a space for a person to write their own gender experience (Traditional and external feelings of sexual attraction is essential Forms: Gender: M F More Inclusive Forms: Gender: ______) to living an authentic life via the union of body and Do not ask your client about their genitals Develop resources in the community for transgender support mind” (McKenzie, 2010, pg. 99) Provide training for all staff about affirmative treatment for transgender and intersex people • “All of us, therapists, gender scholars, and others Collaborate with local organizations to start initiatives to improve trans should respect all people and, insofar as possible, and intersex quality of life Provide workshops or lectures for professionals in order to reduce stigma facilitate the individualized, yet always socially Learn about antidiscrimination policies for your state and identify ways to influenced and contextualized choices they believe include gender identity in places it has been omitted will increase their happiness.” (Gardiner, 2013, pg. Organize a letter writing campaign to insurance companies to cover medical benefits for sex reassignment surgery. Write letters to medical 124) organizations to outline the importance of delaying unnecessary genital reconstructive surgery for intersex infants
References • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. • American Psychiatric Association. (2013). Gender dysphoria. American psychiatric association. Retrieved from http://www.dsm5.org/Documents/Gender%20Dysphoria%20 Fact%20Sheet.pdf • Budge, S., Adelson, J., & Howard, K. (2013). Anxiety and depression in transgender individuals: The roles of transition status, loss, social support, and coping. Journal of Consulting and Clinical Psychology, 81(3), 545-557. • Cornish, J., Schreier, B., Nadkarni, Henderson Metzger, & Rodolfa. (2010). Handbook of Multicultural Counseling Competencies. Somerset: John Wiley and Sons. • Facts and Statistics. (2015). Retrieved February 24, 2015, from http://transgendersociety.yolasite.com/statistics.php • Gardiner, J. (2013). Masculinity’s interior: Men, transmen, and theories of masculinity. The Journal Of Men's Studies, 21(2), 112-126. doi:10.3149/jms.2102.112 • Glassman. W. and Hadad, M. (2004). Approaches to Psychology (Fourth Edition). • Goldner, V. (2011). Trans: Gender in free fall. Psychoanalytic Dialogues, 21(2), 159-171. doi:10.1080/10481885.2011.562836 • Harris, A. E. (2011). Gender as a strange attractor: Discussion of the transgender symposium. Psychoanalytic Dialogues, 21(2), 230-238. doi:10.1080/10481885.2011.562849 • Jorgensen, I.S. and Nafsad, H.E. (2004) Positive Psychology: Historical, Philosophical and Epistemological Perspectives. • Lemoire, S. J., & Chen, C. P. (2005). Applying Person-Centered Counseling to Sexual Minority Adolescents. Journal Of Counseling & Development, 83(2), 146-154. • Livingstone, T. (2008). The Relevance of a Person-Centered Approach to Therapy with Transgendered or Transsexual Clients. Person-Centered & Experiential Psychotherapies, 7(2), 135-144. • Longhofer, J. L. (2013). Shame in the clinical process with LGBTQ clients. Clinical Social Work Journal, 41(3), 297-301. doi:10.1007/s10615- 013-0455-0 • McKenzie, S. (2010). Genders and sexualities in individuation: Theoretical and clinical explorations. The Journal Of Analytical Psychology, 55(1), 91-111. doi:10.1111/j.1468-5922.2009.01826.x • Moleiro, C., & Pinto, N. (2015). Sexual orientation and gender identity: review of concepts, controversies and their relation to psychopathology classification systems. Frontiers In Psychology, 61-6. doi:10.3389/fpsyg.2015.01511 • Rogers, C. and Stevens, B. (1967) Person to person: The Problem of Being Human • Timeline of Transgender History. (2015). Retrieved February 24, 2015, from http://transgendersociety.yolasite.com/complete-timeline- of-tg-history.php/ • Webspace.ship.edu/cboer/rogers/html
14